Saccular function in otosclerosis patients: bone conducted-vestibular evoked myogenic potential analysis

Vestibular involvements have long been observed in otosclerotic patients. Among vestibular structures saccule has the closest anatomical proximity to the sclerotic foci, so it is the most prone vestibular structure to be affected during the otosclerosis process. The aim of this study was to investigate the saccular function in patients suffering from otosclerosis, by means of Vestibular Evoked Myogenic Potential [VEMP]. The material consisted of 30 otosclerosis patients and 20 control subjects. All participants underwent audiometric and VEMP testing. Analysis of tests results revealed that the mean values of Air-Conducted Pure Tone Average [AC-PTA] and Bone-Conducted Pure Tone Average [BC-PTA] in patients were 45.28 +/- 15.57 and 19.68 +/- 10.91, respectively and calculated 4 frequencies Air Bone Gap [ABG] was 25.64 +/- 9.95. The VEMP response was absent in 14 [28.57%] otosclerotic ears. A statistically significant increase in latency of the p13 was found in the affected ears [P=0.004], differences in n23 latency did not reach a statistically significant level [P=0.112]. Disparities in amplitude of p13-n23 in between two study groups was statistically meaningful [P=0.009], indicating that the patients with otosclerosis had lower amplitudes. This study tends to suggest that due to the direct biotoxic effect of the materials released from the otosclerosis foci on saccular receptors, there might be a possibility of vestibular dysfunction in otosclerotic patients

Associations between HLA-C alleles and definite Meniere's disease

Both genetic and environmental factors seem to play role in the etiology of Meniere's disease [MD]. Several genes may be involved in susceptibility of MD including Human Leukocyte Antigens [HLA]. The associations between MD and HLA alleles have been previously studied in other populations and certain HLA alleles were shown to be predisposing. The aim of this study was to determine the association between HLA-C allele frequencies and definite MD in patients who refer to Amir-Alam otolaryngology tertiary referral center in Tehran. Patients with definite MD [N=22] enrolled according to the diagnostic criteria of American Academy of Otolaryngology-Head and Neck Surgery [AAO-HNS]. Cases with all 3 symptoms of MD [Vertigo, Tinnitus and lower frequency of sensory-neural hearing loss] were included and those with suspected MD were excluded from study. HLA-Cw allele frequencies were determined in patients non-related healthy controls [N=91] using PCR -SSP. We found that the frequency of HLACw[*]04 was significantly higher in patients compared to the controls [P = 0.0015, OR; 20, 95% CI [3.7-196.9]]. Our results revealed that HLA-C is a genetic predisposing factor in definite MD in patients who refer to Amir-Alam otolaryngology tertiary referral center

Prophylactic effect of dexamethasone on postoperative nausea and vomiting in patients undergoing stapedectomy surgery

Nausea and vomiting after middle ear surgery as one of the most common complications after surgery is considered to become the ground for the incidence of other adverse consequences. The aim of this study was to evaluate the effect of 16 mg prophylactic intravenous dexamethasone on postoperative nausea and vomiting after stapedectomy. In a randomized double-blind controlled trial study, 70 patients candidate for stapedectomy divided into two equal groups, using the same sedation by single surgeon. While the case group received 16 mg Dexamethasone half an hour before surgery, the control group received 4ml intravenous saline as a placebo. Patients controlled 1-24 hours after the surgery in terms of nausea and vomiting and dependent variables such as vertigo and tinnitus. 70 patients [38 females and 32 males] were enrolled in this study. The rate of postoperative Nausea and vomiting in Case group was 31/4% [equal to 11 patients] and in control group was 60% [equal to 21 patients]. The different was statistical significant [p=%3]. The prophylactic use of 16 mg intravenous dexamethasone half an hour before surgery can significantly reduce incidence of nausea and vomiting after stapedectomy

evaluation of the relationship between the initiation times of feeding through Jejunostomy and procedure complications after upper gastrointestinal [hypopharynx-esophagus] malignancy

Jejunostomy is a common route for enteral nutrition in patient s with upper gastrointestinal [hypopharynx-esophagus] surgery. The aim of this study was to assess the relationship between the starting time of feeding through Jejunostomy with this resulting complications and suggesting a new guideline to reduce complications of the procedure. In a clinical trial study in Amir-Alam hospital patients with upper gastrointestinal malignancy underwent Jejunostomy in a 3 year- period. The patients divided in two groups and complication rates compared feeding through Jejunostomy group [A] 6 hours after the main surgery and group [B] 3 days after the main procedure. Ninety patients [41 male, mean age: 55 yr of age ranging 20-90yr] with upper gastrointestinal malignancy were recruited. In each group twenty seven [30%] of the patients did not complain of any side effect during enteral nutrition .The complications of Jejunostomy procedure in group [A] 6 hours and in group [B] 3 days after the main surgery was seen in 12/37 [32%] and 13/53[24%] of the patients respectively. Significantly higher incidence of abdominal distention and fever was observed in group [A] patients who underwent enteral nutrition through Jejunostomy 6 hours after the main surgery, compared to group [B] [P=0.001] and [P=0.001], respectively. No significant differences in other complications were observed between the two groups. Feeding through Jejunostomy 3 days after the main surgical procedure shows lower adverse effect and because of its well toleration in upper gastrointestinal tract and hypopharyngeal cancer, this method is recommended for enteral nutrition in these patients